Institute of Urology and Nephrology, University College Hospital, London, UK.
J Sex Med. 2012 Aug;9(8):2138-49. doi: 10.1111/j.1743-6109.2012.02808.x. Epub 2012 Jun 6.
For men with androgen deficiency on testosterone replacement therapy (TRT), clinical concern relates to the development of prostate cancer (PCa).
An updated audit of prostate safety from the UK Androgen Study was carried out to analyze the incidence of PCa during long-term TRT.
Diagnosis of PCa in men receiving TRT, by serum prostate-specific antigen (PSA) testing and digital rectal examination (DRE), and its relation to different testosterone preparations.
One thousand three hundred sixty-five men aged 28-87 (mean 55) years with symptomatic androgen deficiency and receiving TRT have been monitored for up to 20 years. All patients were prescreened for PCa by DRE and PSA along with endocrine, biochemical, hematological, and urinary profiles at baseline and every 6 months. Abnormal findings or rising PSA were investigated by transrectal ultrasound and prostate biopsy. The data were compared for the four different testosterone preparations used in TRT, including pellet implants, Restandol, mesterolone, and Testogel.
Fourteen new cases of PCa were diagnosed at one case per 212 years treatment, after 2,966 man-years of treatment (one case per 212 years). Time to diagnosis ranged from 1 to 12 years (mean 6.3 years). All tumors were clinically localized and suitable for potentially curative treatment. Initiating testosterone treatment had no statistically significant effect on total PSA, free PSA or free/total PSA ratio, and any initial PSA change had no predictive relationship to subsequent diagnosis of cancer.
The incidence of PCa during long-term TRT was equivalent to that expected in the general population. This study adds to the considerable weight of evidence that with proper clinical monitoring, testosterone treatment is safe for the prostate and improves early detection of PCa. Testosterone treatment with regular monitoring of the prostate may be safer for the individual than any alternative without surveillance.
对于接受睾丸激素替代疗法 (TRT) 的雄激素缺乏症男性，临床关注的焦点是前列腺癌 (PCa) 的发展。
对英国雄激素研究进行了前列腺安全性的更新审计，以分析长期 TRT 期间 PCa 的发病率。
接受 TRT 的男性通过血清前列腺特异性抗原 (PSA) 检测和直肠指检 (DRE) 诊断 PCa 的情况，以及与不同睾丸激素制剂的关系。
1365 名年龄在 28-87 岁（平均 55 岁）的有症状雄激素缺乏症且接受 TRT 的男性接受了长达 20 年的监测。所有患者在基线和每 6 个月进行 DRE 和 PSA 以及内分泌、生化、血液学和尿液检查之前，均通过 DRE 和 PSA 进行了 PCa 的预筛查。异常发现或 PSA 升高通过经直肠超声和前列腺活检进行调查。对用于 TRT 的四种不同睾丸激素制剂（包括植入剂、Restandol、美睾酮和 Testogel）的数据进行了比较。
经过 2966 人年的治疗（每 212 年一例），在治疗 212 年后，诊断出 14 例新的 PCa 病例，每 212 年一例。诊断时间范围为 1 至 12 年（平均 6.3 年）。所有肿瘤均为临床局限性，适合潜在的治愈性治疗。开始睾丸激素治疗对总 PSA、游离 PSA 或游离/总 PSA 比值无统计学显著影响，任何初始 PSA 变化与随后的癌症诊断均无预测关系。
长期 TRT 期间 PCa 的发病率与一般人群预期的发病率相当。这项研究增加了大量证据，即通过适当的临床监测，睾丸激素治疗对前列腺是安全的，并提高了 PCa 的早期检测。与没有监测的任何替代方案相比，定期监测前列腺的睾丸激素治疗对个体可能更安全。
